Robotic, fast fix as effective as full surgery for post-hysterectomy sagging vagina

Rochester 20 February 2004An initial Mayo Clinic study has confirmed the effectiveness and durability over time of a patient-friendly, robot-assisted procedure that corrects a complication that can follow hysterectomy. The study, published in the February issue of Urology, is the first in the United States to examine the feasibility of using this method to repair vaginal vault prolapse, or collapsed vaginal walls.

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"The benefit to the patient is dramatic", stated Daniel Elliott, M.D., Mayo Clinic urologist and one of the lead study authors. "It's fast, markedly less painful and a strong repair, with much quicker recovery."

Mayo Clinic is the first medical centre in the United States to offer this procedure, formally called "robotic-assisted laparoscopic sacrocolpopexy". It pins back in place the top of a vagina that has fallen down within the vaginal canal or even outside the vaginal opening.

A drooping vaginal wall most commonly occurs when the top of the vagina falls in on itself as the pelvic floor muscles lose strength following a hysterectomy, which one in nine American women undergo. Following hysterectomy, up to 10 percent of women experience sagging of the vagina that requires surgical repair.

"The uterus acts like an anchor", stated Dr. Elliott. "So, if the vagina loses its support, sometimes it inverts itself and comes out." Signs of vaginal vault prolapse include: incontinence, pain during sexual intercourse, a feeling of fullness in the pelvic region, a sore back, or a lump drooping into the vaginal canal or even protruding outside of the body through the vaginal opening. Women who have this condition may find sitting, standing and walking uncomfortable.

In the traditional full, open surgery for vaginal vault prolapse, women have to undergo a four- to five-day stay in the hospital, a sizable abdominal incision and a recovery period of about six weeks, including abstinence from intercourse. In the new robotic procedure, however, the patient is kept in the hospital only overnight and has a much reduced recovery time, although she is still advised to abstain from intercourse for six weeks. Most importantly, the patients on whom the Mayo Clinic urologists performed the new repair have yet to have any problems with recurrence of the prolapse.

In the new robotic approach, the surgeon operates remotely from a computer terminal, guiding the robotic hand that performs the surgery, rather than standing over the patient. This technique also offers 3D vision, better ability to manoeuvre and reduction of any tremor that might be present in the human hand.

As this study's aim was to test initial feasibility, it included the first five women to undergo the procedure at Mayo Clinic. Prior to the repair, two patients had grade three prolapse and three women were classified as grade four, the highest degree of prolapse. Mayo Clinic urologists have now performed 18 robotic vaginal repair procedures, according to co-author George Chow, M.D., with equally successful or even superior results to those seen in the first five women.